Favorable Outcomes After Arthroscopic Posterior Bankart Repair for Traumatic Posterior Shoulder Instability in Collision Athletes.

PURPOSE: To investigate the postoperative results of arthroscopic posterior Bankart repair for traumatic posterior shoulder instability in collision sports athletes and their clinical characteristics, including injury mechanism, symptoms, physical examination findings, and imaging features.

METHODS: Between January 2011 and April 2022, a retrospective review was conducted of collision-sport athletes who underwent arthroscopic posterior Bankart repair for traumatic posterior shoulder instability at a single institution. The inclusion criteria were posterior instability caused by trauma, absence of generalized joint laxity, and arthroscopic posterior Bankart repair. All the patients had a minimum follow-up of 24 months. Patient demographics, injury mechanisms, imaging findings (evaluated using radiographs, computed tomography, and magnetic resonance imaging, including posterior labral tears, posterior glenoid bone loss, glenoid retroversion, and reverse Hill-Sachs lesions), return-to-play rates, recurrence, and postoperative shoulder pain and Rowe score were evaluated. Pre- and postoperative Rowe scores were compared using the Wilcoxon signed-rank test. A P value of < .05 was considered statistically significant.

RESULTS: Of 517 shoulders operated on for instability, 21 (4.1%) had posterior instability. After excluding 8 cases, 17 shoulders from collision sports athletes were analyzed. The mean age of the athletes was 21.1 years. All patients had a positive posterior apprehension test, and 62% had a positive anterior apprehension test. Imaging revealed posterior glenoid bony defects in 85% of cases. The mean glenoid retroversion angle was 1.6° ± 3.6° as measured on axial computed tomography images. The mean follow-up period was 40.5 ± 22.9 months, and all patients returned to their preinjury level of sports activity at a mean of 6.5 ± 1.0 months postoperatively. At the time of injury, 6 patients experienced a posterior dislocation, one experienced a subluxation, and 6 reported only posterior shoulder pain. Before surgery, 7 patients had no history of complete dislocation, while 6 patients had recurrent dislocations (≥2 times). The mean interval from the first dislocation or symptom onset to surgery was 21.8 ± 20.8 months. The Rowe score improved significantly from 55 (range: 25-75) preoperatively to 95 (range: 50-100) postoperatively (P < .01). The minimum clinically important difference for the Rowe score was 13.4 points, and 92% of patients exceeded this threshold. However, one patient (8%) experienced redislocations, and 4 patients (31%) reported residual pain, with 3 of these cases involving glenoid cartilage lesions at the time of surgery. Although postoperative pain was more common in patients with cartilage lesions (60%) than in those without (13%), this difference did not reach statistical significance (P = .217).

CONCLUSIONS: Arthroscopic posterior Bankart repair for traumatic posterior shoulder instability in collision sports athletes resulted in a low recurrence rate, high return-to-play rate, and clinically meaningful improvement. Although not statistically significant, residual postoperative pain tended to be more common in patients with glenoid cartilage lesions observed at the time of surgery.

LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.